Editor's Note: Medication Therapy Management: What is the Best Model?

Will medication therapy management become a routine part of most dispensing pharmacists' activities, or will a select group of pharmacists handle this role?

Will pharmacy practice changes incorporate medication therapy management (MTM) as a routine part of most dispensing pharmacist activities—or will this role be handled by a select group of pharmacists who may even practice independently of the drug distribution process? I have been pondering this question lately as I think about the opportunities the health care reform law will bring to pharmacy. Both practice models exist currently, and evidence supports the success of both approaches. But which approach is best for the patient? Will we come to a different answer if we asked the question, “Which approach is best for pharmacy and pharmacists?”

The fact that there will be more opportunity to receive reimbursement for MTM seems obvious, because MTM is mentioned throughout the new health care reform law. At the same time, many observers feel that there will be continuing pressure to reduce the drug reimbursement formula, making prescription dispensing activities less profitable. Although we may not like it, more health plans are forcing patients to use mail-order pharmacy for chronic disease medications, thus taking prescription volume from local pharmacies. These observations lead me to conclude that a pharmacy business model that relies primarily on filling prescriptions may be in trouble over the next 5 to 10 years.

Maybe we can turn the tide so that the prescription product is no longer perceived by many as just another commodity, but I am not so sure. If we want to do that, more dispensing pharmacists will need to increase their face-toface communication with the patient. Performing an MTM intervention is one way to convey that we are interested in helping that patient make the best use of their medication. It will also help convey to that patient that pharmacists are knowledge workers—not just glorified technicians—as the pharmacist discusses the appropriate use of the medications with the patient.

One MTM provider quoted in the March 2010 Medication Therapy Management Digest puts it this way— “Customers have a greater respect and trust in our pharmacists. Patients are more apt because of this to recommend our pharmacy to their physicians, friends, and family.” Another provider said, “Our clients/patients become longterm patients. They tell other patients and relatives to come to us. The wordof- mouth extends beyond our community to relatives and tourists who arrange for phone consultations.”

If MTM can provide so much value to patients and pharmacy, why do we need to wait for a payer to reimburse us? Shouldn’t we just offer the service and charge the patient directly? Why are pharmacists so reluctant to just ask for the money? I wish I knew the real reason, but our profession has been giving away valuable services forever. There may have been a time when giving advice for free created customer loyalty that pharmacists made up for in other sales. Today, customer loyalty is harder to depend upon to assure increased business. I am also aware that many pharmacists are introverts. Maybe it is hard for that personality type to “ask for the money.”

Not every patient may be ready to pay for such a service out-of-pocket, but some are. More will be willing to pay for the service once they are made aware of its value. Pharmacists can help make that happen by providing MTM services to those patients whose Medicare Part D plans offer the service through a local pharmacist. Offering the service to select other patients as a fee-for-service option can further grow that business. If getting paid for cognitive service delivery is critical to assure community pharmacy success in the future, becoming comfortable doing this needs to begin now. What is keeping you from getting started? %u25A0

Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.

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